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Scenario

You are asked to review a febrile 2-month-old infant who presented to the accident and emergency department. The urine analysis carried out before your arrival is suggestive of urinary tract infection (UTI) (urine dipstick: positive for nitrites and white blood cells (WBCs); microscopy: 220 WBCs per high powered field). On examination the infant appears well and has no signs suggestive of meningitis. However, you recall a senior colleague stating that young infants with UTI should always have a full septic workup to rule out co-existing bacterial meningitis. You wonder if there is any evidence to support routinely performing a lumbar puncture in this setting?

Structured clinical question

In an infant with UTI [patient], is a lumbar puncture [test] indicated to rule out co-existing bacterial meningitis [outcome]?

Search strategy and outcome

Search of the Cochrane Library database using the terms ‘Urinary Tract Infection’ and ‘pyelonephritis’ retrieved 18 Cochrane reviews, none of which were relevant. Medline was searched using the PubMed interface (1950—to date/no limits set): (1) a keyword search using (Urinary Tract Infection OR pyelonephritis OR cystitis) AND (meningitis OR meningoencephalitis OR lumbar puncture) AND (neonat* OR infant) retrieved 507 publications, of which 11 were relevant,1,–,11 and (2) a search using the MeSH terms (‘Infant, Newborn’ OR ‘Infant’) AND ‘Urinary Tract Infections’ AND ‘Central Nervous System Infections’ retrieved 172 publications, but no further relevant papers were identified. Search of the ISI Web of Science (1900—to date), EMBASE (1980—to date) and Scopus (1900—to date) using the same keyword strategy as above yielded 106, 328 and 163 matches, respectively, among which no, two1213 and one12 further relevant paper(s) were identified. Publications that described a group of fewer than 30 infants with UTI and …

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